替诺福韦可降低乙肝后肝硬化患者门静脉压力及血浆内皮素含量  

Tenofovir can down-regulate the portal vein pressure and serum endothelin-1 for patients with hepatitis B-related cirrhosis

作　　者：李佳璇 戴世学[2] 谢宏民 LI Jiaxuan;DAI Shixue;XIE Hongmin(Department of Gastroenterology,Zhongshan Chen Xinghai Hospital of Integrated Traditional Chinese and Western Medicine,Zhongshan 528415,China;Department of Geriatric Gastroenterology,Guangdong Provincial People's Hospital,Southern Medical University,Guangzhou 510080,China)

机构地区：[1]中山陈星海中西医结合医院消化内科,广东中山528415 [2]南方医科大学附属广东省人民医院老年消化科,广东广州510080

出　　处：《分子影像学杂志》2025年第2期205-210,共6页Journal of Molecular Imaging

基　　金：广东省自然科学基金面上项目(2018A030313161);中山市科技局社会公益与基础研究项目(220119104248043)。

摘　　要：目的探索经拉米夫定(LAM)联合阿德福韦酯(ADV)抗乙肝病毒的乙肝后肝硬化患者转换为替诺福韦(TAF)治疗后对门静脉高压、血浆内皮素-1(ET-1)及肝硬化相关并发症的影响。方法纳入2021年1月~2023年1月中山陈星海中西医结合医院LAM联合ADV转换为TAF的患者100例给予TAF治疗,随访24月,比较入组前(T1)、治疗第6月末(T2)、治疗第12月末(T3)、治疗第18月末(T4)及治疗第24月末(T5)共5个时间点的肝功能、甲胎蛋白(AFP)及病毒指数、门静脉相关参数、腹部超声、肾功能、ET-1及肝硬化并发症的发生率差异。结果TAF可降低乙肝后肝硬化患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)、乙肝表面抗原(HBsAg)及乙肝病毒DNA(HBV-DNA)表达含量,可提高血清白蛋白(ALB)含量(P<0.05);TAF治疗后T1~T5时间点的门静脉直径、门静脉压力、门静脉血栓、脂肪肝及脾肿大发生率差异均有统计学意义(P<0.05);血尿素、肌酐及尿酸的差异均无统计学意义(P>0.05),但T1~T5时间点的ET-1、消化道出血发生率的差异有统计学意义(P=0.012、0.042)。相关性分析显示,ET-1均与门静脉直径、门静脉压力、门静脉血栓、消化道出血发生率均呈正相关关系(P<0.05)。结论LAM+ADV转换为TAF后可降低ET-1含量,并改善乙肝后肝硬化患者肝功能、降低病毒荷载、改善门静脉高压及其并发症,且对肾功能无明显影响。Objective To explore the effects of tenofovir(TAF)on portal hypertension,plasma endothelin-1(ET-1)and the incidence of cirrhosis-derived complications,for patients with hepatitis B-related cirrhosis who had previously been treated with lamivudine(LAM)combined with adefovir dipivoxil(ADV).Methods A total of 100 patients were enrolled into the group of"switching from LAM+ADV to TAF"and were treated with TAF and underwent a follow-up for 24 months in Zhongshan Chen Xinghai Hospital of Integrated Traditional Chinese and Western Medicine from January 2021 to January 2023.The liver function,alpha-fetoprotein(AFP)and viral index,portal vena-related parameters,abdominal ultrasound,renal function,ET-1,and liver cirrhosis-derived complications were observed and compared at the following 5 time points:before enrollment(T1),at the end of the 6th month(T2),at the end of the 12th month(T3),at the end of the 18th month(T4),and at the end of the 24th month(T5),respectively.Results TAF was found to significantly down-regulate the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptides(GGT),total bilirubin(TBIL),hepatitis B surface antigen(HBsAg),and hepatitis B virus DNA(HBV-DNA)in patients with posthepatitis B-related cirrhosis.The levels of serum albumin(ALB)was significantly increased after TAF treatment(P<0.05).There were significant differences in portal vein diameter,portal vein pressure,portal vein thrombosis,fatty liver,and splenomegalgia among the time span from T1 to T5,after TAF treatment(P<0.05).There were no significant differences in blood urea,creatinine or uric acid after TAF treatment when compared with pre-treatment(P>0.05).However,changes of ET-1 from T1 to T5 were significantly different(P=0.012),as well as the incidence of gastrointestinal bleeding(P=0.042).Correlation analysis showed that ET-1 was significantly positively correlated with portal vein diameter,portal vein pressure,portal vein thrombosis,and the incidence of gastrointestinal bleeding(P<0.05).Conclusion Swi

关 键 词：乙肝后肝硬化 替诺福韦 血浆内皮素-1 门静脉高压 并发症 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]